The majority of aesthetic surgery relies on the accurate alteration of both underlying tissue and skin to enhance shape and contour. Lipoplasty, liposuction, or liposculpture is a surgical technique to remove and sculpt subcutaneous fat (fat below the skin) in order to reduce volume and improve contour and shape of various anatomic regions. In general these include the neck, arms, chest, back, hips, thighs, buttocks, knees, calves, and ankles. Results and therefore patient satisfaction are dependent on the patient's anatomy (shape and size), skin quality (the ability of the skin to shrink is in part dependent on its elasticity) and, as I will discuss below, surgical technique.

Lipoplasty varies considerably from office to office. The nuances of an individual surgeon's technique greatly influence the overall result and potential complications. I feel that the use of the 'tumescent' technique, now widely employed by most lipoplasty surgeons, and the use of small diameter cannulas to minimize trauma and help sculpt the fatty tissue are of vital importance. There are two additional modifications that are not universally employed and that I believe greatly enhance the ability of the surgeon to deliver a more accurate and dramatic aesthetic result. These are superficial

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lipoplasty and lateral decubitus positioning of the patient on the operating table. These techniques were popularized by Dr. Marco Gasparotti of Rome and adopted by me in 1990.

Conventional lipoplasty removes deep fatty deposits, those furthest away from the under- surface of the skin. This technique effectively reduces fatty bulges, or volume. However, because of the thickness of the underlying fatty layer that is left attached to the skin, retraction or shrinkage is uncertain. Skin is the passive participant in lipoplasty; the superficial technique is the only way to enhance retraction or shrinkage. Superficial lipoplasty removes fat closer to the undersurface of the skin, making the skin and attached subcutaneous fat thinner and more pliable so that it more readily conforms to the underlying contour.

Visualization of the new silhouette on the operating table is critical when sculpting the body during lipoplasty. Use of the lateral decubitus position during surgery of the hip, buttocks, and thigh (three of the most common areas for lipoplasty) greatly enhances aesthetic contours of the feminine midsection. The technique positions the patient on her side so the surgeon can visualize and create a smooth sweep from waist to mid-lateral thigh while enhancing buttock shape. Certain maneuvers performed during this technique help simulate the effects of gravity on the buttock which greatly impact on the hip and thigh silhouette.

To further enhance these techniques, I also utilize a more recent innovation known as power assisted liposuction, or PAL. PAL replaces the conventional cannula and improves its method of action, thereby reducing trauma to the area being treated. Decreased friction at the skin incision results in faster healing and smaller scars. Patients also report less swelling, fewer bruises and little to no discomfort.